neonatalINTENSIVE CARE

Vol. 26 No. 4July-August 2013

VLBW FEEDINGBACTERIAADVANCESIVFE-HEALTH

neonatal INTENSIVE CARE Vol. 26 No. 4 n July-August 2013 17

BILI VALUESBiliBaby,availableatBiliBaby.com,isagraphicaldecisionsupporttoolfortheanalysisofbilirubinlevelsasafunctionofage.Thebaby’sageinhoursorthedate-timeofbirthareenteredaswellasthegestationalageandbirthweightcategories.Oneormorebilirubinvaluescanbeenteredwiththedate-timeortheageinhoursatwhichthetestwasobtained.Theresultsaredisplayedonthefamiliarphototherapyguidelinechart,theexchangetransfusionguidelinegraph,andtheriskpredictiongraph.Theriskfactorsthatimpactdecision-makingaroundphototherapyandexchangetransfusionareexplicitlyenumerated,andthegraphsdynamicallyupdatedependingontheriskfactorsentered.Specificfollow-upinstructionsinlinewithpublishedrecommendationsarehighlightedanddisplayedbasedonthebilirubinandtheinfant’sriskstatus.Thegraphscanbeprintedandincludedwiththepatient’schart.Unlikeothertools,BiliBabyincludesalloftheapplicablechartsandrecommendationsforbilirubinassessment.It’seasytouseandcomprehensive,andthegraphicalpresentationhelpstheclinicalstaffinterpretthedataandrecommendations.BiliBabycanbeuseduniversallybynursesanddoctorsforallbabiesatthetimeofdischargetoassesstheriskofseverehyperbilirubinemia.Combinedwithadherencetothefollow-uprecommendations,itisbelievedtheriskofkernicteruscanbereduced.BiliBabyisafreeweb-basedapplicationthatispoweredbytheanalyticalgorithmsusedinCribNotes,theNICUEHRsystem.GotoBiliBaby.comtoviewandusethetool,orcontactcribnotes.com,(800)323-9167.

COMPANY PROFILE

NeoRayImproveyourneonate’soutcomeandenhanceearlydischargewiththeNeoRayDigitalImagingSystem,nowofferedbySwissrayInternational,Inc.ItwasdevelopedspecificallyfortheNeonatalIntensiveCareUnitincooperationwithNICUdoctorsandnurses,andistheonlyFDA510(k)approvedX-raysystemspecificallydesignedforneonates.

NeoRayisahighlyportable,lightweight,fullyfunctionalX-raysystem,andcanminimizeproceduretimebydisplayingX-rayimagesinjustsecondsatbedside,facilitatingquickplacementoflifesupportingdevicessuchasUVC,endotrachealtubesandPICClines.ECMOcannulation,broviacplacement,duodenaltubesandneedleaspirationareanumberofotherproceduresthatwillbenefitfromthisdevice.

Utilizingadigitalflatpanelthatrefreshesitselfinseconds,NeoRayminimizestheneedforre-positioningX-raycassettesorCRcassettesforrepeatX-raysandreducestheneedforrepeatingsterilizationprocedures.Withitssmallfootprint,NeoRaycanbeusedandstoredwithintheNICUreducingtheriskofcrosscontaminationoftheimagingunitbetweentheNICUandotherareasofthehospital.

Thisdigitalimagingunitutilizessensitivecesiumiodidedigitalreceptorswhichrequirelessexposure,thereforedecreasing“radiationdose”between50%and70%whencomparedtofilmorCRtechnology.Itscompactimagereceptorpanelisprotectedbyanoutercasetopreventdamage.

TheNeoRayDigitalImagingSystemfeaturesa19”highresolutiondisplaymonitor,andfullyfunctionalcustomworkstation,whichsimplifiesNICUworkflowanddocumentation.Theworkstationalsofeaturesautoimageoptimization,automaticshutters,imageannotation,measuringtools,imageenhancementtools,PACSworklist,networkandstorageandisDICOMcompliant.AnoptionalDAPMeterChamberisalsoavailablesotheX-raydosecouldberecordedforeachimage.

ThepurchaseofNeoRayincludesthreedaysofonsiteapplicationstrainingandatwelvemonthstandardwarranty.ForadditionalinformationonhowNeoRaycanbenefityourfacility,pleasecontactuseitherviaemail,info@swissray.comorbytelephone,(800)503-9943.

PRODUCT UPDATEMAICO Diagnostics’ MB 11 Beraphone Infant Hearing Screening System: Hearing Screening Company saves $340,000 in disposable fees

InfantHearingScreeningSpecialists(IHSS)providesnewbornhearingscreeningservicesfor55hospitalsacrossthestateofCalifornia.In2009,IHSSbeganusingtheMAICOMB11BERA-phoneauditorybrainstemresponse(ABR)screeningsysteminmanyofourhospitals,replacingthetraditionalABRscreeningsystemsthatusedisposableelectrodesandearcouplers.TheBERAphonefeaturesreusablestainlesssteelelectrodesandareusableearcushion,avoidingtheexpenseofdisposablesandof-feringaneco-friendlyscreeningABRoption,reducingtheamountofwaste.Asmallamountofwater-solubleelectrodegelisusedtopreparethebaby’sskinattheelectrodesitesandadisinfectantwipeisusedtodisinfectthedeviceafteruse.Consideringthecostoftheseconsumables,eachscreeningusingtheBERAphonecostsapproximately$0.25forsupplies.Thisisincontrasttothe$1.00-13.00perscreeningthatIHSSspentusinglegacyOAEandABRscreeningdevices.In2012,IHSSscreened72,509newbornsusingtheBERAphoneforacostsavingsof$340,000.00 comparedtowhatitwouldhavecostusingdisposables.

In2012,theaveragereferrateacrossthe30IHSShospitalsinwhichtheBERAphonewasusedwas3.1%witharangeof1.1-5.7%.ThisreferratewascomparabletothereferratesachievedinotherhospitalsthathavenotyettransitionedtotheBERAphone.

ThetransitionfromatraditionalABRscreenertotheBERAphonepresentedsomeearlychallengesforscreeningstaff.TheBERAphonemustbehand-heldoverthebaby’seartomaintainelectrodecontacttothescalpduringthescreening.Theskinpreparationprocedurewasdifferentfromtheotherdevicestheyhadbeenusing.Changingthebehaviorofindividualswhohadbecomecomfortablewithadevicethatuseddisposableswasnoteasyforeveryone.TherewasaperiodofresistanceandfrustrationfromsomeofthescreenersastheyworkedtomasterthenewprocedureandtechniquesneededtousetheBERAphone.

UsingtheMAICOMB11BERAphone,IHSSissavingmoneyandreducingwastesenttolandfills,whilecontinuingtoprovidehighqualityhearingscreeningoutcomesforourpartnerhospitals.IHSSscreenershaveadaptedtotheBERAphoneandnowpreferContinued on page 23…

neonatal INTENSIVE CARE Vol. 26 No. 4 n July-August 2013 23

24 AndersonPJ,DeLucaCR,HutchinsonE,RobertsG,DoyleLW,andVictorianInfantCollaborativeGroup.UnderestimationofdevelopmentaldelaybythenewBayley-IIIscale.ArchPediatrAdolescMed.2010;164:352-356.

25 MentLR,VohrB,AllanW,KatzKH,SchneiderKC,WesterveldMW,etal.Changeincognitivefunctionovertimeinverylow-birthweightinfants.JAMA.2003;289:705-11.

26 TysonJE,YounesN,VerterJ,WrightLL.Viability,morbidity,andresourceuseamongnewborns501to800-gbirthweight.JAMA.1996;276:1645-51.

27 TysonJE,ParikhNA,LangerJ,GreenC,HigginsRD.Intensivecareforextremeprematurity-movingbeyondgestationalage.NEnglJMed.2008;358:1672-80.

28 StollBJ,HansenNI,BellEF,ShankaranS,LaptookAR,WalshMC,etal.NeonataloutcomesofextremelypreterminfantsfromtheNICHDNeonatalResearchNetwork.Pediatrics.2010;126:443-56.

29 CosteloeK,HennessyE,GibsonAT,MarlowN,WilkinsonAR.TheEPICurestudy;Outcomestodischargefromhospitalforinfantsbornatthethresholdofviability.Pediatrics2000;106:659-71.

30 BarttonDG.CommitteeonFetusandNewborn.Antenatalcounselingregardingresuscitationattheextremelylowgestationalage.Pediatrics.2009;124:422-27.

41(11a/27)

43(3/7)

64(35/55)

33(5/15)

53(8/15)

27(4/15)

47(7/15)

67(10/15)

40(6/15)

50(7/14)

50(7/14)

50(7/14)

75(21/28)

85(58/68)

63(24/38)

50(19/38)

45(17/38)

76(29/38)

61(23/38)

55(21/38)

67(24/36)

89(32/36)

75(27/36)

94(47/50)

87(60/69)

80(32/40)

73(29/40)

65(26/40)

85(34/40)

80(32/40)

75(30/40)

84(32/38)

79(30/38)

90(34/38)

96(49/51)

75(164/219)

64(64/100)

59(59/100)

50(50/100)

74(74/100)

68(68/100)

60(60/100)

68(64/94)

77(72/94)

73(69/94)

91(125/137)

43(3/7)43

(3/7)

43(3/7)43

(3/7)

57(4/7)

17(1/6)

17(1/6)100(8/8)

50(3/6)

Survival (%)

Normal weight (%)

Normal length (%)

Normal HC (%)

Normal HS (%)

ROP-free (%)

NormalBSID (%) C

NormalBSID (%) MO

NormalBSID (%) C + MONormal and Mild

BSID (%) CNormal and Mild

BSID (%) MONormal and Mild

BSID (%) C + MO

BSID = Bayley scales of infant development; C = Cognitive; MO = Motor; Normal = Normal BSID; Mild = Mild-disabilityBSID; HC = Head circumference; HS = Hearing screen; ROP-free = No grade 3 or 4 ROP; a = One 22 weeks GA survivinginfant was included in the 23 weeks GA category; b = Universal hearing screen started in 2003; Hearing screen andretinopathy of prematurity examination-results are at the time of discharge from the NICU

Table 4b. Risk factors for survival of 22 - 26 weeks’ gestation infants

Table 4a. Survival, cognitive and motor outcomes of 23 - 26 weeks’ gestation infants

Gestational age (week)

23 24 25 26Overall

Outcome23-26

AnalyzedInfants

(N)

219

100

100

100

100

100

100

94

94

94

137b

66(23/35)

76(44/58)

92(56/61)

70(7/10) 164

Variable

Total patients(N = 219)

N

Deceased(N = 55)

184 37 67

34 62

21 38

34 62

24 44

21 38

8 14

2 4

44 80

11 20

29 53

26 473 5

114105

77

80

95

36

8

174

45

84135

7

P value

< 0.0001

<0.0001

0.1187

0.6617

1.000

0.0158

0.3704

Steroids

Hispanic

Asian

Singletons

Multiples

Delivery

Vaginal

Male

Black

Cesarean

IUGR status

Female

Apgar score <7at 5 min

Ethnicity

White

N %

Alive(N = 164)

147 90

80 49

84 51

43 26

56 34

74 45

28 17

6 4

130 79

34 21

55 34

109 664 2

N %

79(130/164)

ittodisposable-basedABRdevices.TheirexperiencewiththeBERAphoneisthattestingisfasterthanwithtraditionalsystems.Additionally,thereislessdiscomfortforthebabysincetherearenoadhesivedisposablestoremoveafterthescreening,whichparentsgreatlyappreciate.

IHSSnowusestheMAICOMB11BERAphoneastheABRscreen-ingdeviceofchoicein34ofitshospitalsandisworkingtowardreplacingallremainingtraditionalsystemscurrentlyinuse.

Product update…continued from page 17